PrEP: Testing new solutions for better outcomes

In recent years, Thailand has made great progress in reducing HIV infection rates among children and improving treatment access. The next challenge is increasing prevention – especially among at-risk youth and adolescents – by promoting measures like pre-exposure prophylaxis (PrEP) and raising awareness in schools and communities.In Bangkok,

BANGKOK, Thailand, 1 December 2016 – 18-year-old Kawee* lives in a single rented room with his mother, a supermarket cashier. His father abandoned them both when he was very young. When he was around 15, he found out he had HIV after several years of unprotected sex with older men.

“I always knew I was different than other boys,” Kawee says. “I had my first boyfriend when I was 12. He was 34. After that I had many different boyfriends. I never used a condom.”

It wasn’t until he was 14 that Kawee found out about HIV through sexuality education at school. “My teacher taught us about HIV, showed us images of AIDS patients, which was scary,” he says. “But I carried on having sex without condoms … I didn’t think HIV would affect me.”

Within a year, Kawee started developing AIDS symptoms, including loss of appetite and diarrhoea. He searched online and found a clinic that did anonymous HIV tests. His result was positive. “I was shocked and confused,” he recalls. “I didn’t know what to do. My mother couldn’t accept what had happened, but I told my teacher and she helped me through it. She said ‘I will always be at your side to support you’.”

These days, Kawee is healthy. He takes his antiretroviral (ARV) medicine regularly and practices safe sex. He also attends counselling sessions at SEARCH Thailand, where he is training to be a peer educator. But he still struggles with stigma and discrimination.

Focus on prevention

In 2015, every two minutes an adolescent was newly infected with HIV. There is no cure, but we know exactly how transmission happens and we know how to prevent it. The vast majority of these new infections are happening in developing countries, but projections show new infections could rise where they were formerly on the decline 32 per cent of new HIV infections among adolescents aged 15–19 happened outside of sub-Saharan Africa.

While the prevention methods we know about are effective, such as condoms and clean needles, trends over the past decade prove that a lack of knowledge and misconceptions persist, and we must continue to pursue new and innovative ways to stop the spread of HIV.

Today, the closest intervention we have to a vaccine is pre-exposure prophylaxis (PrEP) – a new prevention tool that both scientists and those most at risk of HIV are excited about. PrEP is a combination of two existing drugs that treat HIV, and is most effective when used in combination with other prevention methods. Taken daily, oral PrEP can lower the risk of getting HIV from sex by up to 90 per cent. But it must be taken regularly, and those using PrEP must have regular tests to confirm their HIV status.

In 2015, the World Health Organization recommended the use of PrEP to prevent HIV acquisition in individuals at substantial risk of infection. The recommendation emphasized the need to offer PrEP as an additional prevention choice, to be used as part of a combination HIV prevention package. While earlier evidence on the efficacy of PrEP was in the adult population, emerging evidence from the USA and South Africa indicates that PrEP is safe and efficacious in adolescents from 15 to 19 years old.

Youth Voices Count

While Thailand has made great progress in reducing HIV infection rates among children and improving treatment access in the past few years, the challenge now is prevention among those most at risk, especially adolescents. UNICEF is working with partners to determine whether PrEP can be effectively implemented as part of a comprehensive package of HIV prevention services that will empower adolescents to make informed sexual choices and stay safe from HIV.

One of UNICEF’s partners is Youth Voices Count, a network of young gay men and transgender women in Asia-Pacific. Niluka Perera, 27, an advocate for the group, says that following consultations with UNICEF, their members found PrEP to be an “agent of empowerment”. It gave them the means and the motivation to take charge of their health to prevent HIV.

“All of us are human. We have feelings, and they can overpower our informed choices. Maybe … your partner doesn’t want to use a condom. With PrEP you can make the decision to be safe in advance,” Niluka explained.

Youth Voices Count is working with UNICEF to reach young people across Asia-Pacific and increase understanding of PrEP. “We want to raise awareness of PrEP, counter the myths, and create demand,” Niluka says. “To do this we need to reach, not just young gay men, but also their parents and teachers. There are cultural barriers in many Asian countries, but sex education can help normalize this.”